Ablation device with articulated imaging transducer

ABSTRACT

A system for imaging and treating tissue comprises a probe having a deflectable distal tip for carrying an imaging array and a delivery needle for advancement within a field of view of the imaging array. Optionally, the needle will carry a plurality of tines which may be selectively radially deployed from the needle. The imaging array will preferably be provided in a separate, removable component.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application is a continuation-in-part of U.S. patent applicationSer. No. 13/023,383 (Attorney Docket No. 31992-711.301), filed Feb. 8,2011, which is a continuation-in-part of application Ser. No. 12/198,861(Attorney Docket No. 31992-711.201), filed on Aug. 26, 2008; thisapplication is also a continuation-in-part of U.S. patent applicationSer. No. 12/973,587 (Attorney Docket No. 31992-706.301) filed Dec. 20,2010, which is a continuation of U.S. patent application Ser. No.11/564,164 (Attorney Docket No. 31992-706.501) filed Nov. 28, 2006, nowU.S. Pat. No. 7,874,986, which is a continuation-in-part of applicationSer. No. 11/409,496 (Attorney Docket No. 31992-706.201) filed Apr. 20,2006, now U.S. Pat. No. 7,815,571, the full disclosures of which areincorporated herein by reference.

BACKGROUND OF THE INVENTION

1. Field of the Invention

The present invention relates generally to medical devices and methods.More particularly, the present invention relates to an imaging andtherapy device having a deployable treatment needle or needles and apivotal imaging array.

Uterine fibroids are benign tumors in the uterine wall and are the mostcommon tumor of the female pelvis. Fibroids afflict up to 30% of womenof childbearing age and can cause significant symptoms includingdiscomfort, pelvic pain, mennorhagia (excessive bleeding), anemia,infertility, and miscarriage. While fibroids may be located in themuscle (intramural), adjacent to the endometrium (submucosal), or in theouter layer of the uterus (subserosal), and can grow up to severalcentimeters in diameter.

Current treatments for fibroids include both pharmaceutical and surgicalintervention. Pharmaceutical treatments include the administration ofNSAIDS, estrogen-progesterone combinations, and the like. Medications,however, are generally ineffective and are palliative rather thancurative. Surgical interventions include myomectomy, where fibroids areremoved in an open surgical procedure requiring laparotomy and generalanesthesia, and hysterectomy, involving complete surgical removal of theuterus. Both these procedures are long and have significant blood loss.

As improvements over open surgical procedures, several minimallyinvasive procedures have been developed. Laparoscopic myomectomy is alaparoscopic procedure requiring highly skilled laparoscopicgynecologists. Uterine artery embolization relies on blocking theuterine artery supplying blood to the fibroid by injecting smallparticles. While sometimes effective, common complications of arterialembolization include infection, premature menopause, and severe pelvicpain. A third approach relies on complete endometrial ablation, which isgenerally effective for treating bleeding but less reliable for treatingfibroids.

More recently, and of particular interest to the present invention, theuse of radiofrequency needles and other ablation elements for treatingindividual fibroids via a transvaginal approach has been proposed. Asdescribed, for example, in U.S. Patent Publications 2006/0189972;2007/0179380; and 2008/0033493, each of which is commonly assigned withthe present application, a probe carrying a curved needle is used totreat individual fibroids. The probe carries on-board ultrasonic orother imaging so that the needle can be guided into the fibroid underdirect observation. While highly effective in many cases, accurateadvancement of a curved needle into a fibroid can be problematic.Moreover, use of a single needle does not always deliver sufficientenergy to fully ablate relatively large fibroids.

For these reasons, it would be desirable to provide alternative devicesand methods for treating, ablating, or removing uterine fibroids andother tissue masses. It would be particularly desirable if such methodsand devices were able to treat uterine fibroids which are large,difficult to penetrate, or which otherwise resist treatment with curvedand laterally deployed needles. At least some of these objectives willbe met by the inventions described below.

2. Brief Description of the Background Art

The following US Patent Publications discussed above are relevant to thepresent invention: 2006/0189972; 2007/0179380; and 2008/0033493. Seealso US Patent Publication 2007/0249936. The disclosures of each ofthese applications is incorporated herein by reference.

BRIEF SUMMARY OF THE INVENTION

The present invention provides apparatus and methods for imaging andtreating fibroids and other tumors and tissue masses located in thewalls of a uterus or other body cavity. The apparatus and systemscomprise a straight shaft having a distal end and a proximal end. Adelivery needle, preferably straight, is reciprocatably coupled to theshaft, typically being mounted in a straight lumen in the shaft, so thata tissue-penetrating tip of the needle can be distally advanced from theshaft along an axial path. The delivery needle may carry tines forming aneedle array, deployable from within the delivery needle. A tip or otherstructure is pivotally attached to the distal end of the shaft and ismoveable between a position parallel to the axial path and a position atan acute or right angle relative to the axial path. The pivotable tipcarries or comprises an ultrasonic imaging array, and the tip can beoriented to align a field of view of the imaging array with the needleas the needle is advanced along the axial path.

The combination of a straight shaft, delivery needle, and pivotallyattached tip or imaging array has a number of advantages. The straightshaft and needle can be advanced with precision into tissue surroundingthe body cavity, where the needle can be made sufficiently strong toresist unwanted deflection of the type which could occur with otherneedle configurations. The use of a delivery needle and shaft alsoenables and facilitates the deployment of a needle array, including aplurality of tines, from the delivery needle to increase the volume oftissue being treated with the needle array. The pivotable imaging arrayallows straightening of the imaging array to provide a low profile forintroduction through the cervix into the uterus, while also allowingreorientation to cover a wide range of viewing fields after entering theuterus or other body cavity to permit locating fibroids and other tumorsand to further follow the advance of the needle array into the fibroidsor other tumors. It should be noted that in the preferred embodiment,the delivery needle is for delivery only, and does not providetreatment. In alternative embodiments, the delivery needle may be usedfor treatment. The pivotable tip further allows the effective field ofview of the ultrasound image to be increased by pivoting the tip, whichhas the effect of sweeping the ultrasound image. The tip may be pivotedto enhance the view of the delivery needle and/or the needle array,including tines.

In a preferred embodiment, an imaging and therapeutic delivery systemincludes a straight shaft having a distal end and a proximal end and astraight needle reciprocatably coupled to the shaft so that atissue-penetrating tip on the needle can be distally advanced from theshaft along an axial path and a tip pivotally attached to the distal endof the shaft and movable between a position parallel to the axial pathand a position at an acute or right angle relative to the axial path. Anultrasonic imaging array is carried by the pivotally attached tip,wherein the tip can be oriented to align a field of view of the imagingarray with the needle as it is advanced along the axial path so as tosweep the ultrasound field of view relative to the needle and anatomy tobe imaged. The tip is offset from the axial path of the needle.

In certain preferred embodiments, an imaging and therapeutic deliverysystem includes a straight shaft having a distal end and a proximal end.A needle is reciprocatably coupled to the shaft so that atissue-penetrating tip on the needle can be distally advanced from theshaft along an axial path, said needle exiting said shaft at an angle of0 degrees relative to said shaft. A tip is pivotally attached to thedistal end of the shaft and movable between a position parallel to theaxial path and a position at an acute or right angle relative to theaxial path. An ultrasonic imaging array is carried by the pivotallyattached tip, wherein the tip can be oriented to align a field of viewof the imaging array with the needle as the needle is advanced along theaxial path so as to sweep the ultrasound field of view relative to theneedle and anatomy to be imaged.

In the preferred embodiment, the imaging array will be formed on animaging core, where the imaging core is removably positionable in thestraight shaft so that the imaging array extends into the pivotallyattached tip. The straight shaft will usually be rigid while the imagingcore is relatively flexible, allowing the imaging core to bend at thepoint where the tip is pivotally attached to the shaft. In alternateembodiments, the needle assembly may be attached directly to theultrasound probe or the imaging core may be hinged at the point wherethe tip is pivotally attached to the shaft.

In certain preferred embodiments, the delivery needle will carry aneedle array having at least one tine which can be advanced from thedelivery needle, usually carrying a plurality of tines, where the tinesare reciprocatably attached to the delivery needle to permit deploymentand retraction, usually after the delivery needle has been advanced intotarget tissue. A plurality of tines will usually be arranged to radiallydiverge from the delivery needle as the tines are distally advanced.Optionally, at least one additional tine may be reciprocatably mountedon the delivery needle in a range to be advanced axially from theneedle, often forming a center axis to a symmetric deployment ofradially diverging tines. In order to localize the treatment, the tinesmay be electrically conductive while the delivery needle itself iselectrically non-conductive or insulating. In such cases, the tines maybe arranged to be connected to a single pole of an electrosurgical powersupply in order to provide for monopolar treatment. Alternatively, acertain number of the tines may be adopted to one pole of the powersupply while others are connected to the other pole, providing forbipolar treatment.

In certain exemplary embodiments, the imaging and therapeutic deliverysystem will further comprise a handle attached to the proximal end ofthe straight shaft. The handle may include a lever coupled to thepivotally attached distal tip by one or more pull rods. The lever can bepulled or pushed to actuate the pull rod(s) to pivot the tip.Additionally, the handle may include a first slide mechanism coupled tothe delivery needle, where the slide mechanism can be reciprocated toadvance and retract the needle along the axial path. In the embodimentswhich include the plurality of tines, the tines may be reciprocatablyattached to the delivery needle and connected to a second slidemechanism on the handle, optionally being disposed on the first slidemechanism itself, to advance and retract the tines relative to theneedle. Optionally, a stop structure may be disposed on the pivotallyattached tip so that the stop structure prevents advancement of theneedle when the tip is parallel to the axial path of the needle.

The present invention also comprises methods for treating uterinefibroids. The methods include introducing a straight shaft into theuterus. Uterine fibroids are then located using an ultrasonic imagingtransducer carried by or formed as part of a pivotable tip attached to adistal end of the shaft. The tip is pivoted to reposition a field ofview of the ultrasonic transducer carried by the tip. Optionally, thetip may block advancement of the needle when disposed parallel to theshaft (prior to deployment) and allow advancement when pivoted from theparallel orientation. A delivery needle may be axially advanced from thedistal tip of the shaft into tissue near or in a uterine fibroid locatedusing the ultrasonic transducer. Advancement of the needle may beobserved by the transducer by aligning the field of view with the needleadvancement.

In preferred aspects of the methods of the present invention, the shaftis introduced to the uterus via a transvaginal and transcervicalintroduction. Locating fibroids may comprise manually rotating andtranslating the shaft to scan the uterine wall with the ultrasonictransducer. Locating may also comprise pivoting the ultrasonictransducer to adjust the field of view. Optionally, an array including aplurality of tines may be advanced from the delivery needle after theneedle has been advanced into tissue at or near the uterine fibroid.This method will sweep the ultrasound field of view relative to theneedle and anatomy to be imaged. The fibroid is then treated bydelivering energy from the needle and/or tines into the fibroid,typically radiofrequency energy, including both monopolar and bipolarradiofrequency energy. Usually, the tines will be electrically active todeliver the radio frequency energy while the delivery needle iselectrically non-conductive to limit the distribution of energy in theuterine wall or other tissue being treated.

BRIEF DESCRIPTION OF THE DRAWINGS

FIGS. 1A and 1B are perspective views of an imaging and therapeuticdelivery system constructed in accordance with the principles of thepresent invention shown with portions broken away. In FIG. 1A, adelivery needle and array including radially diverging tines areretracted within the shaft of the device, and a pivotally attached tipis shown in axial alignment with the axial deployment path of theneedle. In FIG. 1B, the delivery needle and associated tines are shownin their deployed configuration with the pivotally attached tip shownoriented at an acute angle relative to the axial advancement path of theneedle.

FIG. 2 illustrates the imaging and therapeutic delivery system of FIGS.1A and 1B in cross-section. FIG. 2A is a detail of the distal tip of thedevice illustrated in FIG. 2. FIGS. 2B and 2C illustrate a stopstructure on the pivotally attached tip which prevents needleadvancement prior to deployment of the tip.

FIGS. 3A and 3B illustrate the pivotal tip deployment mechanism indetail, also in cross-section.

FIGS. 4A-4C illustrate the relative movement of the deployment mechanismand the pivotal tip, as the deployment mechanism is actuated.

FIGS. 5 and 6 are side and top views of the imaging and therapeuticdelivery system shown with portions broken away in a non-deployedconfiguration.

FIGS. 7 and 8 are views similar to FIGS. 5 and 6, except that thedelivery needle has been deployed and the pivotally attached tip hasbeen positioned at an acute angle.

FIGS. 9 and 10 are views similar to FIGS. 5 and 6 and FIGS. 7 and 8,respectively, further illustrating the deployment of the needle array,comprising radially diverging tines from the delivery needle.

FIGS. 11A and 11B illustrate deployment of the delivery needle and tinesinto tissue.

FIG. 12 illustrates a system without an ablation needle.

DETAILED DESCRIPTION OF THE INVENTION

Referring to FIGS. 1A and 1B, an imaging and therapeutic delivery systemconstructed in accordance with the principles of the present inventioncomprises a straight shaft assembly 12 including a hollow rod 14 and aneedle tube 16. A tip 18 which is adapted to receive an ultrasonicimaging array (shown in broken line at 38) is pivotally attached to adistal end 20 of the hollow rod 14 of the straight shaft assembly 12. Aneedle and tine array 21 (FIG. 1B) is deployed through a lumen orcentral passage in the needle tube 16 at a distal end 20 of the shaftassembly 12. A handle assembly 22 is attached to a proximal end 24 ofthe straight shaft assembly 12 and includes a pivoting mechanism 26,typically found on its lower surface as illustrated, for selectivelypivoting the imaging array tip 18 between a low profile configurationwhere the tip 18 is axially aligned with the axis of the shaft assembly12, as illustrated in FIG. 1A, and a deflected configuration where thetip 18 is oriented at an acute or right angle relative to the axis ofthe shaft, as illustrated in FIG. 1B. The tip 18 may be placed in itsaxially aligned, low profile configuration for introduction to the bodycavity, for example through the cervix into the uterus, and may beshifted to its deflected configuration in order to image tissue and/orto track deployment of the needle/tine array 21. As described in moredetail below, the pivoting mechanism 26 includes a lever 28 which may bemanually retracted from the distally advanced configuration shown inFIG. 1A to the proximally retracted configuration shown in FIG. 1B inorder to pivot the tip 18.

The handle 22 will also include a delivery needle/tine deploymentmechanism 30 which includes a first slide subassembly 32 and a secondslide subassembly 34. The handle will usually further include a port 36at its proximal end. Port 36 allows introduction of an ultrasonic orother imaging core, where the imaging core has an imaging array 38,typically an ultrasonic imaging array as described in detail incopending application Ser. No. 11/620,594; and parent application Ser.Nos. 11/564,164; and 12/973,587, the full disclosures of which areincorporated herein by reference. The proximal end of the handle willalso allow electrical connections to be made to the needle/tine array.Additionally, the distal end of the handle will provide a standard luerconnection for the infusion of non-conductive coupling fluids.

Optionally, a stop structure 19 may be attached to an upper surface ofthe pivotally attached tip 18, as illustrated in FIGS. 2B and 2C. Whenthe tip 18 is parallel to the axis of the shaft (hollow rod 14), thestop structure 19 will block the advancement path of the needle 16 (asshown in FIG. 2B). This is advantageous since it prevents accidentalneedle advancement while the shaft assembly 12 is in the introductoryconfiguration. Deployment of the tip 18, as shown in FIG. 2C, moves thestop structure 19 out of the advancement path of the needle 16, asdescribed below.

Referring now to FIGS. 2, 2A, 3A, and 3B, operation of the pivotmechanism 26 for selectively deflecting the tip 18 disposed at thedistal end of the straight shaft assembly 12 will be described. Forclarity, components of the first slide assembly 32 and second slideassembly 34 have been removed from the view in FIG. 2. The tip 18 ispivotally attached at the distal end 20 of the straight shaft assembly12 by a pivot pin 40 or similar structure, as best seen in FIG. 2A. Apair of pull rods 42 are attached at anchors 44 so that drawing thewires in a proximal direction will deflect the tip 18 from an axiallyaligned configuration, as shown in broken line in FIG. 2A, to thedeflected configuration, as shown in full line in FIG. 2A. The rods 42extend through tubes 46 disposed on each side of the hollow rod 14 ofthe shaft assembly 12. As best seen in FIGS. 3A and 3B, the rods 42 areattached at their proximal ends to a rotating anchor 50 disposed inlever 28. Thus, by drawing the lever 28 proximally, as shown in FIG. 3A,the tip 18 may be laterally deflected, as shown in full line in FIG. 2A.Conversely, by pushing the lever 28 in a distal direction, as shown inFIG. 3B, the tip 18 may be returned to the axially aligned configurationas shown in broken line in FIG. 2A. The lever 28 is pivotally attachedto the body of handle 22 by a pivot pin 48 so that the anchor 50 isoffset from the point of rotation of the lever 28. Thus, the anchor 50is actually translated as the lever is rotated back and forth about thepivot pin 48.

A locking pin 52 allows the lever 28 to be selectively locked in placeto hold the pivot tip 18 in a fixed orientation. Locking pin 52 ismounted in a central passage 54 of the lever 28 and carries a pin 56which seats in one of a plurality of pockets 58 formed in an arcuatelocking strip 60. Thus, the lever 28 can be released by pressing the pin52 against spring 62 so that the pin 56 is lifted out of the pocket 58,as shown in FIG. 3A. In this configuration, the lever may be movedfreely back and forth to deploy the tip 18. When the tip 18 is in itsdesired location, the locking pin 52 may be released to permit pin 56 toengage the closest pocket 58 where it is held in place by spring 62. Itwill be appreciated that the lever 28 will typically be advancedforwardly to close the tip 18 to a low profile configuration forintroducing the imaging and therapy delivery system 10 to the patientfor treatment, for example through the cervix into the uterus. Once inplace, the lever 28 can be unlocked using the locking pin 52 andoriented to a desired angle relative to the shaft assembly 12 to permitimaging and, in particular, to allow advancement of the delivery needle70 in the tissue to be observed.

Referring now to FIGS. 4A-4C, use of the lever 28 for deflecting the tip18 is illustrated. Initially, the tip 18 is axially aligned with theaxis of the shaft assembly 12 and the lever 28 is in its forward ordistal-most position, as shown in FIG. 4A. By depressing locking pin 52,as shown in FIG. 4B, lever 28 may be drawn proximally as indicated bythe adjacent arrow, to deflect the tip 18 away from the axis of shaft12, as shown by the arrow adjacent the tip in FIG. 4B. When the lever 28reaches its fully proximal position, as shown in FIG. 4C, the tip 18 hasbeen fully deflected away from the axis of shaft assembly 12. Note thatslide subassemblies 32 and 34 (for extending delivery needle 70 andneedle array 21) have not been activated in FIGS. 4A-4B.

Referring now to FIGS. 5-10, operation of the first slide subassembly 32and the second slide subassembly 34 will be described. For clarity,portions of the pivot mechanism 26 have been removed from these views.Prior to deployment, as shown in FIGS. 5 and 6, the needle/tine array 21is fully drawn into the central passage of needle tube 16. Needle tube16 has an open distal tip 64 through which the delivery needle and tineswill emerge when advanced using the slide subassemblies 32 and 34.

The first slide subassembly 32 comprises a reciprocating carriage 66having a coupling 68 attached to a proximal end of the needle 70. Thecarriage 66 may be axially advanced and retracted by manually pressingbuttons 72 to disengage pins 74 (FIG. 5) from pockets 76 in a straightlocking strip 78. Once the pins 74 are disengaged, the carriage 66 maybe distally advanced, as shown in FIGS. 7 and 8, to advance tip 80 ofneedle 70 from the distal end of the needle tube 16. The buttons 72 maythen be released to allow pins 74 to reenter the adjacent pockets 76 inthe locking strip 78, thus locking the needle 70 in place.

Referring now in particular to FIGS. 9 and 10, a plurality of radiallydiverging tines 82 may be deployed from the distal end of needle 70using the second slide subassembly 34 which includes a thumb slide 84.The thumb slide 84 is reciprocatably carried in the carriage 66 so thatthe thumb slide will advance the tines relative to the needle. The thumbslide is connected to a tine rod 86 which enters a hollow centralpassage or lumen of the needle 70 and is coupled to the plurality oftines 82 so that advancement of the thumb slide 84 from the retractedposition shown in FIGS. 7 and 8 to the distally advanced position shownin FIGS. 9 and 10 causes the tines 82 to emerge from the distal end ofthe needle 70. The tines 82 are preferably formed from a straight,resilient metal, such as stainless steel, nickel titanium, or the like,and are deflected outwardly by ramps (not shown) in the distal end ofthe needle. Optionally, a lockout circuit (not shown) may be provided toprevent energizing the tines if the tines are not fully advanced.

The use of the imaging and therapeutic delivery system 10 of the presentinvention is illustrated in FIGS. 11A and 11B. After imaging using theimaging array 38 carried on or in tip 18, the needle 70 is advanced intotarget tissue identified by the imaging using the first slidesubassembly 32, as shown in FIG. 11A. Usually, the position of the tip18 will be adjusted to assure that travel of the needle 70 into thetissue may be observed. After the location of the needle tip 80 has beenconfirmed, the thumb slide 84 of the second slide subassembly 34 maythen be advanced, as shown in FIG. 11B, to extend the tines 82 into thetissue. In the preferred embodiments of the present invention, theneedle 70 and tines 82 will be rotatably connected to the remainder ofthe device to allow the handle to be rotated, thus rotating the imagingarray 38, to facilitate imaging even after the needle and tines havebeen deployed.

Referring now to FIG. 12, a delivery system 110 without an ablationneedle is illustrated. A deflectable distal tip 126 of the rigid shaft116 may be deflected by the use of pull or tensioning wire(s) housedwithin the shaft 116. Deflection may occur at a true mechanical pivot orat a flexible zone at the shaft distal end 118. As discussed above, whenthe delivery shaft 116 is deflectable by a user, various needles may beused to match the amount of deflection provided by the distal tip 126 aswell as the amount of tilt provided by the ultrasound array 112. Hence,a needle guide 144 will typically be empty until the distal end 118 ofthe shaft 116 is deflected. For example, the shaft 116 may be insertedin a straight configuration. The distal tip 126 may then be deflecteduntil a target anatomy is identified. A needle is then back loadedwithin the guide passage 170 that corresponds to the amount of thedeflection.

Table I below illustrates possible viewing angles κ that may be achievedby the cumulative effects of the shaft bending angle β (e.g., eitherthrough active deflection of the distal tip or a pre-shaped or pre-bentdistal tip) and the ultrasound tilting angle α. The matching needleangles θ based on the possible viewing angles κ are further illustrated.In example 1, the shaft 116 is in a straight configuration so that theviewing angle κ is provided solely by the tilting angle α of theultrasound array 112. In example 4, the needle 114 will have a straightconfiguration. In example 5, a non-tilted and non-bent ultrasound array112 version is covered. It will be appreciated that the viewing angle κwill be more than the bend angle β of the shaft 116 due to the additiveeffect of the tilting angle α of the ultrasound array 112. This allowsthe bend on the distal tip 126 of the shaft 116 to be shallower withoutcompromising the cumulative viewing angle κ, which is of particularbenefit for patient insertion considerations. In the case of adeflectable distal tip 126 in which insertion may be implemented in astraight configuration, the tiled ultrasound angle α still aids inreducing the needle angle θ.

TABLE I Viewing Angle Tilt Angle Bend Angle Needle Angle Example (κ) (α)(β) (θ) 1 7°-10° 7°-10° 0° 80° 2 20° 7°-10° 10°-13° 70° 3 45° 7°-10°35°-38° 45° 4 90° 7°-10° 80°-83°  0° 5  0° 0° 0° 90°

While the above is a complete description of the preferred embodimentsof the invention, various alternatives, modifications, and equivalentsmay be used. Therefore, the above description should not be taken aslimiting the scope of the invention which is defined by the appendedclaims.

What is claimed is:
 1. An imaging and therapeutic delivery systemcomprising: a straight shaft having a distal end and a proximal end; astraight needle reciprocatably coupled to the shaft so that atissue-penetrating tip on the needle can be distally advanced from theshaft along an axial path; a tip pivotally attached to the distal end ofthe shaft and movable between a position parallel to the axial path anda position at an acute or right angle relative to the axial path; and anultrasonic imaging array carried by the pivotally attached tip, whereinthe pivotally attached tip can be oriented to align a field of view ofthe imaging array with the needle as the needle is advanced along theaxial path so as to sweep the ultrasound field of view relative to theneedle and anatomy to be imaged.
 2. A system as in claim 1, wherein thetip is offset from the axial path of the needle.
 3. A system as in claim1, further comprising an imaging core which includes the imaging arraynear a distal end thereof, wherein the imaging core is removablypositionable in the straight shaft so that the imaging array extendsinto the pivotally attached tip.
 4. A system as in claim 3, wherein thestraight shaft is relatively rigid and the imaging core is flexible,wherein the imaging core can bend at the point where the tip ispivotally attached to the shaft.
 5. A system as in claim 3, wherein thestraight shaft is relatively rigid and the imaging core is hinged at thepoint where the tip is pivotally attached to the shaft.
 6. A system asin claim 1, further comprising at least one tine carried by the needle,wherein the at least one tine is reciprocatably attached to the needle.7. A system as in claim 1, further comprising a plurality of tinescarried by the needle, wherein the tines are reciprocatably attached tothe needle.
 8. A system as in claim 7, wherein the ultrasonic imagingarray sweeps the ultrasound field of view relative to the anatomy,needle and plurality of tines.
 9. A system as in claim 7, wherein thetines are arranged to radially diverge from the needle as they areadvanced distally.
 10. A system as in claim 9, wherein at least oneadditional tine is arranged to advance axially from the needle.
 11. Asystem as in claim 7, wherein the needle is electrically non-conductiveand the tines are electrically conductive.
 12. A system as in claim 1,further comprising a handle attached to the proximal end of the straightshaft.
 13. A system as in claim 12, wherein the handle includes a levercoupled to the pivotally attached tip by a pull rod, wherein the levercan be pivoted to pivot the tip.
 14. A system as in claim 13, whereinthe handle includes a first slide mechanism coupled to the needle,wherein the slide can be reciprocated to advance and retract the needlealong the axial path.
 15. A system as in claim 14, further comprising aplurality of tines carried by the needle, wherein the tines arereciprocatably attached to the needle to diverge from the needle as theyare advanced distally, and further comprising a second slide mechanismon the slide to advance and retract the tines relative to the needle 16.A system as in claim 1, wherein rotation of said ultrasonic imagingarray is independent of movement of said needle.
 17. A method fortreating uterine fibroids, said method comprising: introducing astraight shaft into a uterus; locating a uterine fibroid using anultrasonic imaging transducer carried by a pivotable tip attached to adistal end of the shaft; pivoting the ultrasonic transducer toreposition a field of view of the ultrasonic transducer; advancing astraight needle axially from the distal end of the shaft into tissuenear the located uterine fibroid, wherein the needle is aligned in thefield of view; and imaging the needle and the fibroid using theultrasound transducer.
 18. A method as in claim 17, wherein introducingthe shaft comprises transcervical introduction.
 19. A method as in claim17, wherein locating comprises manually rotating and translating theshaft to scan the uterine wall with the ultrasonic transducer.
 20. Amethod as in claim 19, wherein imaging comprises rotating the ultrasoundtransducer independently of movement of said needle.
 21. A method as inclaim 17, wherein locating comprises pivoting the ultrasonic transducer.22. A method as in claim 17, further comprising advancing a plurality oftines from the needle after the needle has been advanced into or nearthe uterine fibroid.
 23. A method as in claim 22, wherein locatingcomprises pivoting the ultrasonic transducer for imaging the pluralityof tines.
 24. A method as in claim 22, further comprising deliveringenergy from the tines into the fibroid.
 25. A method as in claim 24,wherein the energy is radiofrequency energy.
 26. A method as in claim24, wherein the needle remains electrically non-conductive while theenergy is being delivered through the tines.
 27. An imaging andtherapeutic delivery system comprising: a straight shaft having a distalend and a proximal end; a straight delivery needle reciprocatablycoupled to the shaft so that a tissue-penetrating tip on the needle canbe distally advanced from the shaft along an axial path; at least onetreatment needle deployable from said delivery needle wherein saidtreatment needle is reciprocatable within said delivery needle; a tippivotally attached to the distal end of the shaft and movable between aposition parallel to the axial path and a position at an acute or rightangle relative to the axial path; an ultrasonic imaging array carried bythe pivotally attached tip, wherein the tip can be oriented to align afield of view of the imaging array with the delivery needle as thedelivery needle is advanced along the axial path, so as to sweep theultrasound field of view relative to the delivery needle as the deliveryneedle is advanced.
 28. A system as in claim 27, wherein said at leastone treatment needle comprises a plurality of tines.
 29. A system as inclaim 1, wherein the shaft includes a needle tube with a distal most endfrom which the straight needle emerges, wherein the tip is pivotallyattached to the shaft adjacent to the distal end of the needle tube. 30.A system as in claim 27, wherein the shaft includes a needle tube with adistal most end from which the straight needle emerges, wherein the tipis pivotally attached to the shaft adjacent to the distal end of theneedle tube.
 31. An imaging and therapeutic delivery system comprising:a straight shaft having a distal end and a proximal end; a needlereciprocatably coupled to the shaft so that a tissue-penetrating tip onthe needle can be distally advanced from the shaft along an axial path,said needle exiting said shaft at an angle of 0 degrees relative to saidshaft; a tip pivotally attached to the distal end of the shaft andmovable between a position parallel to the axial path and a position atan acute or right angle relative to the axial path; and an ultrasonicimaging array carried by the pivotally attached tip, wherein the tip canbe oriented to align a field of view of the imaging array with theneedle as the needle is advanced along the axial path so as to sweep theultrasound field of view relative to the needle and anatomy to beimaged.
 32. A system as in claim 31, wherein the tip is offset from theaxial path of the needle.
 33. A system as in claim 31, furthercomprising an imaging core which includes the imaging array near adistal end thereof, wherein the imaging core is removably positionablein the straight shaft so that the imaging array extends into thepivotally attached tip.
 34. A system as in claim 33, wherein thestraight shaft is relatively rigid and the imaging core is flexible,wherein the imaging core can bend at the point where the tip ispivotally attached to the shaft.
 35. A system as in claim 31, whereinthe straight shaft is relatively rigid and the imaging core is hinged atthe point where the tip is pivotally attached to the shaft.
 36. A systemas in claim 31, further comprising at least one tine carried by theneedle, wherein the at least one tine is reciprocatably attached to theneedle.
 37. A system as in claim 31, further comprising a plurality oftines carried by the needle, wherein the tines are reciprocatablyattached to the needle.
 38. A system as in claim 37, wherein theultrasonic imaging array sweeps the ultrasound field of view relative tothe anatomy, needle and plurality of tines.
 39. A system as in claim 37,wherein the tines are arranged to radially diverge from the needle asthey are advanced distally.
 40. A system as in claim 39, wherein atleast one additional tine is arranged to advance axially from theneedle.
 41. A system as in claim 37, wherein the needle is electricallynon-conductive and the tines are electrically conductive.
 42. A systemas in claim 31, further comprising a handle attached to the proximal endof the straight shaft.
 43. A system as in claim 42, wherein the handleincludes a lever coupled to the pivotally attached tip by a pull rod,wherein the lever can be pivoted to pivot the tip.
 44. A system as inclaim 43, wherein the handle includes a first slide mechanism coupled tothe needle, wherein the slide can be reciprocated to advance and retractthe needle along the axial path.
 45. A system as in claim 44, furthercomprising a plurality of tines carried by the needle, wherein the tinesare reciprocatably attached to the needle to diverge from the needle asthey are advanced distally, and further comprising a second slidemechanism on the slide to advance and retract the tines relative to theneedle
 46. A system as in claim 31, wherein rotation of said ultrasonicimaging array is independent of movement of said needle.